This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. The prevalence of pediatric hypertension in the United States has almost tripled in the last 40 years, and trends show that not only are the number of hypertensive children increasing, but that their blood pressure levels are also rising. It is well-known that, once considered a disease secondary to renal pathology, pediatric hypertension is increasingly becoming primary in nature, and that this shift has been linked to the childhood obesity epidemic. It has also been established that pediatric hypertension is an independent risk factor of adult cardiovascular disease, and that changes in the levels of certain biomarkers in these patients are related to cardiometabolic disturbances. Yet to be established is the weight status and cardiometabolic profile of the general pediatric population as it relates to their hypertension status. Furthermore, there is a need to define the epidemiologic patterns of pediatric hypertension on the island of Puerto Rico (PR), as no representative, population-based studies exist to date. Our long-term goals are: to achieve early detection of children at risk of cardiovascular disease in order to adequately target prevention efforts, and to identify novel targets for future research aimed at improving the diagnosis, treatment, and prognosis of children with pathological patterns of high cardiovascular risk. The objective for this project is to establish the epidemiology of pre-hypertension and hypertension and to determine the cardiometabolic profile of adolescents in a community-based sample, as a conduit to a larger population-based study and improved clinical knowledge. Our central hypothesis is that the prevalence of pre-hypertension and hypertension in the adolescent sample will be as high as, or higher than, the prevalence rates in the United States, and that these adolescents will have increased risk factors for cardiovascular disease and altered biomarkers for hormonal, metabolic and oxidative disturbances. This hypothesis was formulated based on preliminary data of school children at a school in Cayey, PR, and on preliminary data of hypertensive children seen at our clinic in San Juan, PR. A review of the literature regarding a series of hormonal and oxidative stress markers further supports our hypothesis, and is discussed in the Approach subsection of "Research Strategy". The rationale for this study is that, by having defined epidemiologic patterns for pre-hypertension and hypertension in the pediatric population on the island, and by determining the relationship between the disease and a series or cardiometabolic biomarkers in a community-based setting, we can design a targeted population-based study with innovative, translational approaches to the diagnosis and medical management of hypertensive pediatric patients. We plan to test our central hypothesis and meet the objective of this project by focusing on the following specific aims: 1. Determine the prevalence of pre-hypertension and hypertension in a sample of adolescents. Our working hypothesis is that the prevalence of pre-hypertension and hypertension will be at or higher than 10% and 5% respectively, based on the preliminary data mentioned above. 2. To identify patterns in the levels of biomarkers for hormonal, metabolic and oxidative-stress disturbances as they relate to hypertension status and cardiometabolic risk factors in adolescents. We hypothesize that hypertensive adolescents will be more likely to be overweight and have impaired glucose tolerance and dyslipidemia, and that these will be associated with high levels of oxidative stress and adipokines, and low levels of vitamin D 25OH. The expected outcomes of these aims are: actual prevalence statistics for pediatric pre-hypertension and hypertension, and cardiovascular risk and biomolecular profiles for both healthy and diseased adolescents. These outcomes shall have a positive impact, because they are likely to provide concrete data to guide further population-based projects, and novel translational targets for screening, diagnosis, and intervention intended to curb current trends and improve health outcomes in children and young adults.